What is Ovarian Cancer ?

The term "ovarian cancer" includes several different types of cancer that all arise from cells of the ovary. Most commonly, tumors arise from the epithelium, or lining cells, of the ovary. These include epithelial ovarian (from the cells on the surface of the ovary), fallopian tube, and primary peritoneal (the lining inside the abdomen that coats many abdominal structures) cancer. These are all considered to be one disease process. There is also an entity called borderline ovarian tumors that have the microscopic appearance of a cancer, but tend not to spread much.

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Types of Ovarian Tumors

There are a number of tumors that may start in the ovaries. These tumors can be benign (non-cancerous) or malignant (cancerous). Epithelial ovarian cancer is by far the most common form of ovarian cancer. Germ cell and stromal ovarian cancers are much less common. Ovarian cancer can also result from a cancer somewhere else in the body that has spread-

Epithelial ovarian cancer (epithelial ovarian tumors) - derived from cells on the surface of the ovary. It occurs mainly in adults.

Germ cell ovarian cancer (germ cell ovarian tumors) - derived from the egg-producing cells within the body of the ovary. This rare type of cancer more commonly affects children and teenage girls.

Cancers from other organs in the body can spread to the ovaries - metastatic cancers - a metastatic cancer is one that spreads from where it first arose as a primary tumor to other locations in the body.

Causes of Ovarian Cancer

Ovarian cancer is considered as one of the most common cancer among women. Some of its major causes include -

The usage of hormone replacement therapy (HRT) for more than five years especially when only estrogen is used

Inherited gene mutation

Women who are 50 years or above

Obesity

Family history of breast cancer or ovarian cancer

Having never been pregnant

Having had cancer before such as colon, breast or uterine

Symptoms of Ovarian Cancer

The following are examples of possible early symptoms of ovarian cancer -

Changes in bowel habits like constipation

Pelvic pain

Heartburn or indigestion

Pain on the lower side of the body

Pain during sexual intercourse

Back pain

Urgent and more frequent urination

Pain in the lower stomach

Feeling full rapidly while eating

The progression of ovarian cancer may result into following symptoms that include -

Loss of appetite

Nausea

Breathlessness

Weight loss

Fatigue (tiredness)

Stages of Ovarian Cancer

Stage I - growth of the cancer is limited to the ovary or ovaries.

Stage IA - growth is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites present containing malignant cells. The capsule is intact.

Stage IB - growth is limited to both ovaries without any tumor on their outer surfaces. There are no ascites present containing malignant cells. The capsule is intact.

Stage IC - the tumor is classified as either Stage IA or IB and one or more of the following are present -

tumor is present on the outer surface of one or both ovaries

the capsule has ruptured

there are ascites containing malignant cells or with positive peritoneal washings.

Stage II - growth of the cancer involves one or both ovaries with pelvic extension.

Stage IIA - the cancer has extended to and/or involves the uterus or the fallopian tubes, or both.

Stage IIB - the cancer has extended to other pelvic organs.

Stage IIC - the tumor is classified as either Stage IIA or IIB and one or more of the following are present -

tumor is present on the outer surface of one or both ovaries

the capsule has ruptured

there are ascites containing malignant cells or with positive peritoneal washings.

Stage III - growth of the cancer involves one or both ovaries, and one or both of the following are present -

the cancer has spread beyond the pelvis to the lining of the abdomen

the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.

Stage IIIA - during the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal peritoneal surfaces.

Stage IIIB - the tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.

Stage IIIC - the tumor is in one or both ovaries, and one or both of the following is present -

the cancer has spread to lymph nodes

the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.

Stage IV - this is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and distant metastases (spread of the cancer to organs located outside of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.

Diagnosis of Ovarian Cancer

If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer’s spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop. The following tests are used to diagnose ovarian cancer -

Exploratory Surgery - this surgery is performed for confirming the diagnosis of ovarian cancer.

Ultrasound

Blood Tests - CA 125 blood test is performed for those women who are suspected of having ovarian cancer or previously had ovarian cancer. This blood test helps in detecting a protein antigen that can be found at abnormally high levels in the blood serum of those women who have ovarian cancer.

Positron Emission Tomographic Scan (PET) : This test helps in defining those areas that altered blood supply and also helps in identifying cancer.

Laparoscopy and possibly Endoscopy

Colonoscopy

Abdominal fluid aspiration

CT scan

Magnetic Resonance Imaging (MRI)

Treatment of Ovarian Cancer

Radiation therapy, surgery and chemotherapy are the treatment options for treating ovarian cancer.

Radiation Therapy - although radiation therapy rarely is used to treat ovarian cancer, it may help destroy any cancer cells that are left in the pelvic area. It also may be used if the cancer has come back after other treatments. In most cases, the main goal of radiation therapy is to control symptoms such as pain, not to treat the cancer.

Surgery - surgery is the main treatment for ovarian cancer. Often, surgery is done to remove or biopsy a mass to find out if it is cancer. Once cancer is confirmed, the surgeon stages the cancer based on how far it has spread from the ovaries. If the disease seems to be limited to one or both ovaries, the surgeon will biopsy the pelvis and abdomen to find out if the cancer has spread.

Chemotherapy - you may need chemotherapy after surgery to destroy ovarian cancer cells that are still in the body.

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